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TEMPORARY MEDICAL PERMIT
INFORMATION & INSTRUCTIONS
PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE COMPLETING AND SUBMITTING YOUR APPLICATION. If after reading the instructions you have questions please contact our office.
Indiana Professional Licensing Agency
Medical Licensing Board
402 W. Washington Street, Room W072
Indianapolis, IN 46204
(317) 233-4236 (fax)
FAIR INFORMATION PRACTICE ACT
In compliance with IC 4-1-6, this agency is notifying you that you must provide the requested information or your application will not be processed. You have the right to challenge, correct, or explain information maintained by this agency. The information you provide will become public record. Your examination scores and grade transcripts are confidential except in circumstances where their release is required by law, in which case you will be notified.
Your social security number is being requested by this state agency in accordance with IC 4-1-8-1. Disclosure is mandatory, and this record cannot be processed without it.
NOTARIZED COPY INFORMATION
When submitting a notarized copy of an original document, the notary MUST make a statement to the fact that the notary has seen the original document. If this is not done the document will NOT be accepted.
Please note that we cannot accept dark copies of documents as they are eventually scanned and attached to your information. Documents that are dark do not scan readable. Please send in a normal copy.
STATUTES AND RULES
You may view the statute and rules on our website. For your convenience you may click on the following link: http://www.in.gov/pla/bandc/mlbi/statruls.html
Processing time depends on the Applicant. The applicant is responsible for the submission of all documents. The sooner the documents are requested and received the quicker the permit can be issued. All status updates from our office will be communicated via email. If you have a positive response the permit cannot be issued until it has been reviewed by the Board. The Board meets on a monthly basis.
DOCUMENTS REQUIRED FOR LICENSURE
(When submitting a notarized copy of an original document, the notary MUST make a statement to the fact that the notary has seen the original document. If this is not done the document will NOT be accepted. )
Please type or legible print when completing the application. All information requested on the application must be completed. The application must have an original signature and date.
You must submit one (1) passport quality photo taken within the past three (3) months.
You must submit an application fee in the amount of $100.00; payable to Professional Licensing Agency. All fees are non-refundable and non-transferable.
If you have answered any of the questions on the application “yes” you must submit a NOTARIZED AFFIDAVIT detailing the occurrence/situation, the outcome, date of occurrence, if it is a malpractice payment the amount paid in your behalf. If applicable please submit copies of all court documents and/or arrest records. Letters from attorneys or insurance companies are not accepted in lieu of your statement.
PROOF OF GRADUATION
You must submit proof of graduation by submitting one of the following documents:
A. CERTIFICATE OF COMPLETION – An original letter from the Dean of your medical/osteopathic school stating that you have completed (not expected to) all requirements for graduation and the date when the degree was awarded.
B. OFFICIAL TRANSCRIPT – An official transcript of grades from the medical/osteopathic school, confirming medical degree. Transcripts must come directly from the school in an unopened envelope. Graduates of foreign medical schools must submit notarized copies of all subjects and grades (mark sheets). Include official translation if not in English.
C. DEGREE – A notarized copy of your medical/osteopathic degree. Include official translation if not in English.
The Hospital/Institution Certification (page 3 of your application) must be completed by the Hospital/Institution Chairman Department Head.
EDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATES
If you are a foreign medical graduate, you must submit a notarized copy of your ECFMG certificate. If your ECFMG certificate has an expiration date you must request a permanent validation sticker from ECFMG.
ECFMG Contact Information
3624 Market Street
Philadelphia, PA 19104-2685 USA
Telephone: (215) 386-5900
(Telephone assistance available between 9:00a.m. and 5:00p.m. Eastern Time)
Fax: (215) 386-9196
VERIFICATION OF STATE LICENSURE(S)
You must request a “License Verification or Letter of Good Standing” from each State/Country in which you currently are or have ever been licensed, certified, or registered in any regulated health profession or occupation. This includes all licenses etc., that are active, expired, inactive, retired, delinquent etc. In addition to any medical license/permit etc., this also pertains to any professional health license such as an EMT, Nursing, Pharmacist, etc. You will need to print off the verification form; contact the appropriate entities/states to see if they charge a fee for completing this form and send the form directly to them. They will in turn complete the verification and mail it directly to our office.
We do not accept web verifications; the verification must come directly from the state in which you were licensed in.
The Board no longer automatically sends out pocketcards. The evening that your license is issued, you will receive an email informing you of your license number and how one may purchase/upload a copy of your pocketcard.
Temporary residency permits expire June 30th of every year and may be renewed for $50. A renewal email will be sent out sixty (60) days prior to the expiration. If you change residency programs, you will need to submit a new application. Please be sure to always keep us informed of your current email address.